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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. 2022-06-0596
Regular Panel Decision
Dec 05, 2022

Freeman, Lynn v. 2022-06-0596

Lynn Freeman, an employee of Kirby Pines Estates, sought an expedited hearing to compel her employer to provide a recommended lumbar fusion surgery by her authorized treating physician, Dr. Glenn Crosby, for a back injury sustained in July 2021. The proposed surgery, a transforaminal lumbar interbody fusion (TLIF), was initially denied through utilization review and upheld on appeal, with medical experts citing Official Disability Guidelines (ODG) and a lack of significant spinal instability. While Dr. Crosby supported the surgery and dismissed the guidelines, the Court found the employer successfully rebutted the presumption of medical necessity using the opinions of Drs. Samuel Murrell and Maria Sumas. Their assessments, which aligned with ODG and noted the resolution of Ms. Freeman's radicular complaints, were deemed more persuasive. Consequently, the Court denied Ms. Freeman’s request for the TLIF procedure, setting a status conference for future proceedings.

Lumbar FusionTLIFHerniated DiscRadiculopathyUtilization ReviewMedical NecessityOfficial Disability GuidelinesWorkers' Compensation ClaimsExpedited HearingSpine Surgery
References
4
Case No. 08-11-00331-CV
Regular Panel Decision
Oct 31, 2012

Vincent Maes and Cynthia Maes, as Next Friend of Isabel G. Maes, a Minor Child and the Insurance Company of the State of Pennsylvania v. El Paso Orthopaedic Surgery Group, P. A.

Vincent Maes sustained a spinal injury in 2000 from a motor vehicle accident, leading to a lumbar laminectomy in 2001 by Dr. Paul Cho, an employee of El Paso Orthopaedic Surgery Group, P.A. (EPOSG). Following the surgery, Mr. Maes allegedly experienced severe neurological issues. In 2010, Vincent and Cynthia Maes, acting as next friend for their minor daughter Isabel, along with The Insurance Company of the State of Pennsylvania (ICTSP), filed a lawsuit against EPOSG, asserting claims for Isabel's loss of parental consortium and alleging vicarious liability for Dr. Cho's negligence. EPOSG sought summary judgment, contending that Isabel's claims were time-barred by the two-year statute of limitations applicable to Mr. Maes's original claim and also by the prior dismissal of Mr. Maes's claim with prejudice in 2004. The trial court granted summary judgment in favor of EPOSG. The appellate court affirmed the trial court's decision, ruling that claims for loss of parental consortium are derivative in nature and are consequently extinguished when the statute of limitations on the injured parent's underlying claim expires or when that underlying claim is dismissed with prejudice.

Medical MalpracticeParental ConsortiumSummary JudgmentStatute of LimitationsDerivative ClaimsDismissal with PrejudiceTexas Civil Practice and Remedies CodeHealth Care LiabilityMinor's ClaimsAppellate Review
References
28
Case No. ADJ6619207 ADJ6736606
Regular
May 24, 2010

ALBERTO ALVAREZ vs. AKT DEVELOPMENT CORPORATIONS, INSURANCE OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration of a decision awarding lumbar fusion surgery, finding the WCJ erred by solely relying on the *Cervantes* decision regarding timely utilization review. The Board determined that the defendant's utilization review timeliness was unclear, and the parties had agreed to an Agreed Medical Examiner (AME) to resolve the surgery dispute before *Cervantes* was issued. Furthermore, the Board held that the treating physician's recommendation for surgery must constitute substantial evidence, which was not definitively established here. Therefore, the matter was returned for further development of the record, requiring the treating physician to address the AME's concerns regarding the necessity of fusion surgery.

Workers' Compensation Appeals BoardPetition for RemovalPetition for ReconsiderationJoint Findings Award and OrderIndustrial InjuryLumbar FusionUtilization ReviewCervantes v. El Aguila Food ProductsSubstantial Medical EvidenceExpedited Hearing
References
3
Case No. 03-17-00707-CV
Regular Panel Decision
Nov 21, 2018

CoreALM, LLC v. Keen Fusion, Inc.

CoreALM, LLC appealed a trial court's judgment that awarded Keen Fusion, Inc. damages for tortious interference with contract and business disparagement. CoreALM contended that the economic loss rule barred the award and that the evidence was legally insufficient to support the jury's findings. The appellate court affirmed the trial court's judgment. It determined that the economic loss rule did not preclude Keen Fusion's recovery on its tort claims because the duty not to interfere with contractual relationships arises from common law, independent of any contractual agreement between the interfering party and the party whose contract was interfered with. The court also found factually sufficient evidence to support the jury's finding that CoreALM tortiously interfered with Keen Fusion’s contract with eCommQuest, which proximately caused Keen Fusion to lose an engagement with Johnson Controls. Given the valid finding on tortious interference, the court did not address the challenge to the business disparagement claim.

Tortious Interference with ContractEconomic Loss RuleBusiness DisparagementContract BreachAppellate ReviewFactual Sufficiency of EvidenceProximate CauseCommon Law DutyIndependent Contractor DisputeSubcontractor Agreement
References
17
Case No. 03-03-00435-CV
Regular Panel Decision
Jul 29, 2004

Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission/East Side Surgical Center Clinic for Special Surgery And Surgical and Diagnostic Center, L.P. v. East Side Surgical Center Clinic for Special Surgery/Texas Workers' Compensation Commission Richard Reynolds, in His Official Capacity as Executive Director of the Texas Workers' Compensation Commission

This case involves the Texas Workers’ Compensation Commission's failure to establish fee guidelines for ambulatory surgical centers under the Texas Workers’ Compensation Act. East Side Surgical Center, Clinic for Special Surgery, and intervenor Surgical and Diagnostic Center, L.P. (collectively "East Side") sued the Commission to invalidate certain default rules that applied when specific guidelines were absent. The district court declared one rule (133.304(i)) invalid and enjoined its enforcement, citing unlawful delegation of authority. On appeal, the Court of Appeals reversed the district court's judgment regarding the rule's invalidity and dissolved the injunction, citing a Texas Supreme Court decision finding no unlawful delegation. The court affirmed that East Side was not entitled to its usual and customary fee in the absence of specific guidelines.

Workers' CompensationAdministrative LawDelegation of AuthorityRulemakingAmbulatory Surgical CentersJudicial ReviewInsurance CarrierFee GuidelinesFair and Reasonable RatesStatutory Interpretation
References
38
Case No. 2016-04-0074
Regular Panel Decision
Sep 26, 2016

White, Ransy v. Boles Trucking

Randy White, an employee, filed a Request for Expedited Hearing against Boles Trucking, the employer, seeking medical and temporary disability benefits for a lumbar spine fusion surgery. The alleged work-related injury occurred on February 11, 2015, exacerbating a pre-existing spondylolisthesis. The court evaluated whether the injury primarily arose out of employment and if the aggravation was compensable. Judge Robert Durham found sufficient evidence that Mr. White was likely to prevail, concluding that the February 2015 incident was a specific work-related event that significantly contributed to his current condition and need for surgery. Consequently, the court ordered Boles Trucking to provide the recommended L4-5 spinal fusion and associated medical treatment.

Workers' CompensationSpinal FusionSpondylolisthesisExacerbationPre-existing ConditionCausationMedical BenefitsTemporary DisabilityTruck Driver InjuryLumbar Spine Injury
References
4
Case No. 2021-08-1180
Regular Panel Decision
Dec 10, 2025

HOLLAND, JUDITH v. RANDSTAD

This post-settlement medical benefits case concerns Judith Holland's entitlement to a lumbar fusion surgery ordered by her authorized treating physician, Dr. Samuel Schroerlucke. The employer, Randstad, denied the surgery, which led to a utilization review and an independent medical examination by Dr. John Lochemes, both of which did not recommend surgery. The Court, however, found Dr. Schroerlucke's opinion more credible due to his specialization and long-term treatment of Ms. Holland, concluding that the surgery is medically necessary. The Court also granted Ms. Holland's request for attorney's fees due to Randstad's failure to approve the necessary medical care.

Lumbar Fusion SurgeryMedical NecessityAttorney's FeesUtilization ReviewTreating Physician PresumptionIndependent Medical ExaminationSpinal StenosisRadiculopathyPost-Settlement Medical BenefitsTennessee Law
References
3
Case No. 2017-03-1291
Regular Panel Decision
May 21, 2018

White, Paul v. G&R Trucking, Inc.

This case involves an expedited hearing for medical benefits requested by employee Paul White for a lumbar spine fusion surgery at the L5-S1 level. The dispute centered on whether Mr. White's need for surgery was a direct consequence of a 2005 work injury, previously settled and insured by Gallagher Bassett, or a 2016 injury insured by Riverport Ins. Co. The Court found that Mr. White suffered an aggravation of his L5 condition during physical therapy, which was a direct and natural consequence of his 2016 work injury. Consequently, Judge Lisa A. Lowe ordered Riverport Ins. Co. to provide the necessary medical treatment, including the recommended surgery. The decision also addressed the presumption afforded to treating physicians under Tennessee Code.

Workers' CompensationMedical BenefitsLumbar Spine FusionL5-S1Direct and Natural Consequence RuleTreating Physician PresumptionExpedited HearingCausation DisputeSpinal InjuryPhysical Therapy Aggravation
References
7
Case No. 531582
Regular Panel Decision
May 13, 2021

Matter of Matteliano v. Trinity Health Corp.

Caitlyn Matteliano, a nurse assistant, suffered work-related back, knee, and leg injuries in 2015 and 2018. Her treating orthopedic surgeon, Franco Vigna, requested authorization for multi-level lumbar fusion surgery and an external bone growth stimulator due to persistent pain and degenerative disc disease, despite conservative treatments. The employer denied this request based on an independent medical examination by Anthony Leone, who deemed the surgery aggressive and inappropriate given the lack of instability. A Workers' Compensation Law Judge initially denied the request, but the Workers' Compensation Board approved it. The employer appealed, and the Appellate Division, Third Department, affirmed the Board's decision, finding substantial evidence in Vigna's testimony to support the surgery's authorization under medical treatment guidelines for degenerative disc disease where non-surgical management has failed.

Workers' CompensationLumbar Fusion SurgeryMedical Treatment GuidelinesDegenerative Disc DiseaseDiscogenic Back PainIndependent Medical ExaminationPrior AuthorizationAppellate ReviewNurse AssistantWork Injury
References
9
Case No. 08-06-00071-CV
Regular Panel Decision
Aug 30, 2007

Vincent Maes and Cynthia Maes and the Insurance Company of the State of Pennsylvania v. El Paso Orthopaedic Surgery Group

Vincent and Cynthia Maes and The Insurance Company of the State of Pennsylvania appealed the dismissal of a health care liability suit against El Paso Orthopaedic Surgery Group (EPOSG). The Maeses alleged negligence and vicarious liability against EPOSG after Vincent Maes suffered severe complications following back surgery by Dr. Paul Cho, an EPOSG neurosurgeon. The trial court dismissed all claims against EPOSG, finding the expert reports insufficient to address EPOSG's breach of the standard of care, even for vicarious liability claims. On appeal, the Court reviewed whether an expert report was necessary for vicarious liability claims and if the severance of claims against EPOSG was proper. The appellate court ultimately affirmed the trial court's judgment, upholding the dismissal of all claims against EPOSG and the severance.

Health Care LiabilityMedical MalpracticeExpert Report SufficiencyVicarious LiabilityRespondeat SuperiorDismissal with PrejudiceSeverance of ClaimsSpinal Surgery ComplicationsNeuroscienceOrthopedic Surgery Group Liability
References
17
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